An atypical presentation of posterior reversible encephalopathy syndrome : diagnostic and therapeutic dilemmas

Abstract EN

Anesthetic management in patients with altered sensorium presenting for emergency surgical procedures has always been a challenging task for the attending anesthesiologist.

We report a 21-year-old primigravida who presented to us at term pregnancy with seizures, altered sensorium, and hypertension.

A provisional diagnosis of eclampsia was made clinically, and the patient was taken up for emergency cesarean section under general anesthesia.

She underwent uneventful operative delivery and was successfully extubated.

However, during the postoperative period, she developed high-grade fever and gradually progressive respiratory and cardiovascular depression.

She was shifted immediately to ICU after securing the airway and primary resuscitation.

A possible suggestive differential diagnosis of posterior reversible encephalopathy syndrome was arrived, as postoperative computed tomography of the brain revealed bilateral hypodense cerebral hemispheres involving predominantly parieto-occipital lobes.

Patient improved clinically with aggressive supportive treatment over the next 2 days and was successfully extubated.

Diagnosis of posterior reversible encephalopathy syndrome is often delayed clinically in such circumstances and may lead to permanent neurological damage.

An atypical presentation as in the present case may further add to the diagnostic dilemma and can possibly lead to institution of inappropriate therapeutic interventions.

The present case emphasizes the importance of early recognition of the atypical cases and their timely management by the obstetricians, anesthesiologists, and the intensivists.